This month’s update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: ### Topic: paediatrics #### Outcome rating: head turner Hyperoxia and oxygen toxicity can cause harm in critically unwell children. Given this concern, there is a need to determine if lower oxygen saturation (SpO2) targets are safe. Recent work in adults has demonstrated no harm from the use of lower SpO2 targets.1 2 The Oxy-PICU Study was a pragmatic, multicentre, open-label randomised controlled trial in 15 paediatric intensive care units (PICUs). Children >38 weeks’ corrected gestational age and <16 years admitted as an emergency receiving invasive ventilation were randomised to conservative (88–92%) or liberal (>94%) SpO2 targets. Notable exclusion criteria were brain injury and congenital heart disease. The primary outcome was rank-based duration of organ support at 30 days following allocation, with death the worst outcome and survivors receiving a score between 1 and 30 based on days of organ support. Secondary outcomes were 30-day mortality, time free from invasive ventilation, adverse events, functional status, hospital/PICU length of stay and cost. 2040 children were randomised equally to the two groups. Death and organ support duration during the first 30 days was significantly lower in the conservative group (median 5 (IQR 3–9) days) than in the liberal group (median …

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期刊每月更新前五名

本月的更新是由 EMJ 杂志更新每月前五名核心团队。我们采用多模式搜索策略，利用免费的开放获取医学教育资源和文献搜索。我们确定了五篇最有趣和相关的论文（经共识决定），并强调了每篇论文的主要发现、主要局限性和临床底线。这些论文的排名如下： ### 主题：儿科 #### 结果评级：令人头疼 高氧和氧中毒会对病情严重的儿童造成伤害。考虑到这一问题，需要确定较低氧饱和度 (SpO2) 目标是否安全。最近针对成人的研究表明，使用较低的 SpO2 目标不会造成任何危害。1 2 Oxy-PICU 研究是一项在 15 个儿科重症监护病房 (PICU) 中进行的务实、多中心、开放标签随机对照试验。校正胎龄 >38 周和 <16 岁的儿童因急诊接受有创通气被随机分配至保守 (88-92%) 或自由 (>94%) SpO2 目标。值得注意的排除标准是脑损伤和先天性心脏病。主要结果是分配后 30 天的基于等级的器官支持持续时间，死亡是最差的结果，幸存者根据器官支持天数获得 1 至 30 分之间的分数。次要结局是 30 天死亡率、无创通气时间、不良事件、功能状态、住院/PICU 住院时间和费用。2040 名儿童被随机分为两组。保守组前 30 天的死亡和器官支持持续时间（中位数 5 (IQR 3-9) 天）显着低于自由组（中位数……